A multidisciplinary and multinational team of researchers led by Boston University has been investigating in Nicaragua the cause of chronic kidney disease (CKD) affecting large areas of Central America, following a request filed in 2008 by Nicaragua Sugar Estates Limited (NSEL), a subsidiary of Grupo Pellas, and the Chichigalpa Association for Life (ASOCHIVIDA), the most representative group of kidney patients in the western part of the country.

The group of researchers recently published their latest inquiries on the subject in The Journal of Epidemiology and Community Health (JECH), a prestigious international magazine, specializing in epidemiology and public health.

"None of the established risk factors for CKD appear to play an important role in the epidemic (...)" There is no evidence of high exposure to nephrotoxic metals such as lead or cadmium. "On the other hand, while there are a number of environmental, occupational and behavioural factors to which the affected population is potentially highly exposed and that can cause injury to the kidney under certain circumstances, they are not known to cause CKD or certainly not on such a large scale", state the researchers in their essay.

According to the authors of this publication, most of the focus in previous studies has been on exposure to factors that would occur in early adulthood. However, they report the results from a recent pilot study, in which they analysed several biomarkers of tubular kidney damage among adolescents with no prior history, which showed a pattern of higher levels of these markers among adolescents living in areas of high adult CKD mortality.

"If confirmed, these results would suggest the additional possibility that initial damage may be occurring at an early age",indicates one of the most important findings of the team. They clearly believe that identifying the cause(s) of this epidemic is a challenge that will require the investigation of multiple possible risk factors and may require the demonstration of a previously undescribedmechanism capable of causing CKD.

"In addition, increased coordination among research groups within Central America and in other countries where similar epidemics have been described would be of great benefit", expressed the researchers.

"The inter-related need for science and public health action is hardly unique to this epidemic, and the global health community has repeatedly demonstrated its capability to tackle this type of problem.It is our hope that the community will bring its considerable intellectual resources to identify the causes of this puzzling epidemic and halt the suffering it has caused", adds the publication.